Radiation-induced morphea - a literature review.

Radiation-induced morphea (RIM) is a rare and under-recognized skin complication of radiotherapy. It is commonly wrongly diagnosed as other dermatological conditions or malignancy because of similar clinical characteristics. This literature review analyses 66 cases that have been reported in the literature since 1989. The clinical appearance often includes pain and disfiguration of affected area, which may influence the patient's quality of life. There is no clear connection between the radiotherapy dose, the fractionation scheme, the use of a boost, age, the presence of other dermatological conditions or other connective tissue diseases and the occurrence of RIM. Its pathogenesis is still unclear, but several theories are proposed to explain this phenomenon. The available data suggest that the abnormally high secretion of some cytokines (interleukin 4, interleukin 5, transforming growth factor) induced by radiation causes an extensive fibrosis after an activation of fibroblasts. Histological confirmation is crucial in distinguishing RIM from similar-looking diseases, such as chronic radiation dermatitis, cancer recurrence, radiation, recall dermatitis, new carcinoma or cellulitis. There is no clear treatment regimen for this condition. Clinical outcome after therapy is often unsatisfactory. The commonly used methods and agents include: topical and systemic steroids, calcineurin inhibitors, systemic immunosuppressants including methotrexate, tacrolimus, heparin, hyaluronidase, phototherapy (UVA, UVA1, UVB, PUVA), systemic antibiotics, imiquimod, mycophenolate mofetil, photophoresis. The differential diagnosis is challenging and requires a multidisciplinary approach to avoid misdiagnosis and to plan appropriate treatment.

[Statistical correlations of the duration of survival and prognostic factors in the group of patients with Hodgkin's disease]. / Zaleznosci statystyczne dlugosci przezycia od czynników rokowniczych w grupie chorych na ziarnice zlosliwa.

Statistical relationships of the duration of survival and selected prognostic factors, in the group of 192 patients with Hodgkin's disease irradiated in the years 1965-1975 in the Institute of Oncology in Warsaw are discussed. The analysis of the multiple regressions has been performed and correlation coefficients of Pearson calculated. It has been found that following factors most effectively affect the prognosis: age, degree of remission obtained following first treatment and sex. The factor most strongly connected with the duration of the remission of the disease appears to be the degree of obtained remission.

[Comparison of the effectiveness of different methods of irradiation using metronidazole as a radiation-sensitizing agent in patients with laryngeal cancer. Controlled clinical studies]. / Porównanie skutecznosci róznych metod napromieniania z uzyciem metronidazolu jako radiouczulacza u chorych na raka krtani. Kontrolowane doswiadczenie kliniczne.

Randomized controlled clinical trial has been carried out in the Oncology Center in Warsaw and Medical Academy in Lódz to assess the effectiveness of application of Metronidazole as radiosensitizer of hypoxic cells in patients with squamous cell laryngeal cancer treated by Cobalt60 irradiation in the years 1982-1986. Clinical estimation has been obtained by comparison of the effectiveness of four selected methods of dose fractionation (conventional, dynamic, dynamic with Metronidazole, irradiation twice a day) in which NSD and TDF have been comparable (1950, 116). Metronidazole has been applied intraorally six times for a total treatment with 6 g doses. The tolerance of the drug has not been very good: 72% of patients has nausea and/or vomiting. No other side effects have been observed. Major mucosal reactions appeared in patients in which the dose have been fractionated by non conventional method (large fractions, twice daily irradiation). No statistically significant differences in the immediate effect of the radiotherapy and 3 year survival among the groups of patients treated by investigated methods have been found.